Comparison of coronary calcifications detections by angiogram versus intravascular ultrasound

The presence, extent and location of calcium in coronary artery lesions are important determinants of the success of per cutaneous coronary intervention [PCI]. Although coronarography remains the gold standard for coronary disease detection, Intravascular ultrasound [IVUS] is proposed as a superior technique for identifying patients with coronary artery calcification .To define sensibility and specificity of coronary angiography in detecting calcifications considering the IVUS as gold standard. Target lesion calcification was assessed in 40 patients [35 men; mean age 57.4 +/- 10 years] by angiography and intravascular ultrasound. Ultrasound detected calcium in 51 of 85 target lesion [60%], whereas angiography showed calcifications in only 16 lesion [19% p<0.001 compared with IVUS]. Coronary angiography detected 8% of 0-45[degree sign] arc calcium category, 7% of 45-90[degree sign] calcium category, 58% of 90-180[degree sign] calcium category, and 80% of more than 180[degree sign] calcium category. The overall sensitivity of angiography in identifying calcium was 31% and increased with an increasing arc of lesion associated calcium. The overall specificity of the angiographic detection of target lesion calcium was 100%. Intra coronary ultrasound analysis shows that target lesion calcification is much more widespread in coronary artery disease than what angiography reveals. The sensitivity of angiography was poor, with although a very high specificity

[Coronary angiographic characteristics in septuagenarian patients with acute coronary syndrome]

Although the prognosis of acute coronary syndrome [ACS] in elderly patients is bleak, elderly population is less well treated both in medical and interventional terms. To analyse angiographic findings in septuagenarian patients admitted with ACS and its impact on the therapeutic strategy. We retrospectively analysed 250 patients 70 years or older hospitalised for ACS who underwent a coronary angiography between January 2006 to september2010. This population was more likely to be male with mean age 74 years and 93% of ACS were inaugural events [60% N STEM, 40% STEMI].Coronary angiograms showed complex, diffuse coronary lesions with a high incidence of multivessel coronary artery disease, bifurcation lesions, and calcified stenosis. Angiographic findings after ACS in elderly were caracterised by multivessel disease and complex lesions .Surgical or percutaneous coronary revascularizaion was possible in the majority of these patients

[Results of cardiac pacing: about 188 patients]

Indications for permanent pacing are currently well codified. This treatment may, however, present complications. To report the results of cardiac pacing and to identify predictive factors of pacing's complication. We conducted a retrospective study of 188 consecutive patients admitted to the cardiology department of Mongi Slim university hospital in La Marsa between January 2005 and June 2011 and implanted with a single or dual chamber pacemaker. In our study, we had 92 men and 96 women [sexratio= 0.95]. The mean age was 70.21 +/- 13 years. The indication for cardiac pacing was a high degree heart block in 74.46% of cases and a sick sinus syndrome in 15.95% of cases. The degeneration conduction tissue was the main etiology [72.34% of patients]. Success implantation was obtained in 98.4%of cases. The main operative complication was the pneumothorax in 3 patients [1.59% of cases]. At Long term, cumulative survival rate was 78.95%. Only operating time affects significantly the rate of early complications [p<0.001]. Late complications were related to the valvular heart disease [p = 0.007], the ischemic etiology [p = 0.05], the oral antivitamine K treatment [p = 0.04] and the occurrence of early complication [p = 0.002]. Our hospital, which is considered as a small Center of cardiac pacing [less than 80 procedures/year] had a low complication rate as well as big centers

A Successful Dissolution of an Obstructive Prosthetic Mitral Valve Thrombus: Sequential Two and Three Dimensional Transesophageal Echocardiography Examination

No abstract available.

[Single versus bilateral internal thoracic artery grafts for multi vessel coronary artery bypass grafting: effects on mortality and event-free survival]

The issue of superiority of single internal thoracic artery grafting versus bilateral internal thoracic artery grafting remains unresolved. The aim of this study was to compare the early results and midterm outcome of single and bilateral internal thoracic artery grafting for multivessel coronary artery bypass grafting. Between January 2005 and March 2010, 196 patients underwent primary coronary artery bypass grafting with at least one internal thoracic artery grafts. Early results and Outcomes of patients undergoing single internal thoracic artery [SIMA] plus saphenous vein grafting [n=145] and bilateral internal thoracic artery [BIMA] plus saphenous vein grafting [n=51] were obtained at a mean follow up of 29 months. Patients with bilateral internal thoracic artery grafting were younger, had less hypertension, higher left main disease and better Euroscore than patients undergoing single internal thoracic artery grafting. In-hospital mortality was similar for the two groups: 6.9% for patients undergoing SIMA versus 5.9% for those undergoing BIMA [p=0.8]. Sternal wound infection was also similar [2.8% versus 3.9% p=0.68]. Mid-term mortality was [4% VS 4.8% p=0.71] and event free survival probability at 28 months was 75% for the single-graft group compared with 85.7% for the bilateral-graft group [P =0.46]. Our study found similar early and mid-term clinical outcomes for patients undergoing SIMA plus saphenous vein grafting and those undergoing BIMA plus saphenous vein grafting for multivessel coronary artery bypass grafting

[Coronary artery bypass grafting in diabetic patients: early and mid-term outcomes]

The outcome of coronary artery bypass grafting [CABG] in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. To evaluate the early and mid term outcomes of diabetic patients compared to non-diabetics following CABG. We retrospectively analyzed the data of 228 CABG patients from January 2005 to December 2010: one hundred and twenty-six diabetics and 102 non-diabetic. Diabetic patients were more likely to be female[27% Vs 12.7% P=0.009] were less smoker [55.6% Vs 80.4% P<0.0001] with higher rate of three vessel disease[67.5% Vs 42.2% P=0.005] compared to non-diabetics. Hospital mortality was significantly higher among diabetic patients [16% Vs 4.1% P=0.005].Length of care unit stay was more important [2.3 days Vs 2.1 days P=0.048], but with a similar rate of sternal wound infection even after bilateral internal thoracic artery grafting. After 28 months mean follow- up, mid-term survival of diabetics was significantly decreased compared to no-diabetics [91% Vs 99% p<0.001] .However, Event-free survival was similar in the two groups [76% Vs 80% p=0.82]. These results suggest that diabetes is associated with poorer early and mid-term outcomes following [CABG]

[Atrial fibrillation following coronary artery bypass grafting: Predictors and mid- term outcome]

Atrial fibrillation [AF] is a frequent complication after coronary artery bypass grafting [CABG] which increase morbidity and hospitalization length. To identify the predictors of atrial fibrillation and its repercussion on hospital and mid-term outcomes in patients undergoing [CABG]. We undertook a retrospective review of the data of 224 patients undergoing CABG. The mean age of the patients was 60.8 years. Atrial fibrillation was diagnosed from serial postoperative electrocardiogram. Twenty two patients developed postoperative atrial fibrillation. Multivariate analysis showed that only: age, left circumflex stenosis, sternal wound infection and low cardiac output were predictors of AF following CABG. Hospital mortality was similar in the two groups [5% Vs 9.6% P=0.7]. In our study, the incidence of post-CABG atrial fibrillation was 9.8%. Multivariate predictors were age, left circumflex lesion, sternal wound infection and low cardiac output. Hospital mortality and mid-term outcome were similar in the two groups

Prolapsus valvulaire mitral et mort subite: a propos d'une observation

Mitral valve prolapse [MVP] is a commun disorder that, in general, has a good prognosis. Rare occasions of sudden death have been reported in patients with MVP and it is presumed that the basis of sudden death is arrythmias. We report a case of a 47 years old men affected by MVP complicated by ventricular arrhythmias and sinoatrial block; who died suddently from ventricular tachycardia. The pathophysiology and risk factors of sudden cardiac death in MVP are discussed

[Hypertrophic cardiomyopathy and pregnancy]

We report the case of a 32 years old patient, with a known diagnostic of hypertrophic cardiomyopathy; who has presented at the first trimester of pregnancy a ventricular fibrillation treated by electric shock with a favorable outcome. The risks for the mother and the fetus are discussed; The recommendations for the conduct of the delivery are reviewed